A U.S. DEPARTMENT OF AGRICULTURE FOOD SAFETY AND INSPECTION SERVICE
PASTEURIZED EGG PRODUCTS RECOGNIZED LABORATORY PROGRAM INFORMATION UPDATE REQUEST FORM |
The detailed information on this update is considered proprietary and will not be released. However, a list of Recognized Laboratories complete with addresses, telephone numbers, and contact personnel is distributed.
1. Laboratory Name: _____________________________________________________________
(Official Name)
Doing business as (if applicable): __________________________________________________
Address: ___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
City: _____________________________ State: ___________ Zip: ____________
3. PEPRLab Number: ___________________________ (Not the USDA egg-plant establishment number)
4. Laboratory Director: ___________________________________________________________
Telephone Number: ____________________________________ Ext. ___________________
Fax Number: _________________________________________
E-mail Address: _______________________________________
5. Microbiology Lab Supervisor: ___________________________________________________
Official Title: ________________________________________________________________
Telephone Number: ____________________________________ Ext. ___________________
Fax Number: _________________________________________
E-mail Address: _______________________________________
6. Contact Person for PEPRLab business _____________________________________________
Title: _______________________________________________________________________
Telephone Number: ______________________________ Ext. _________________________
Fax Number: _________________________________________
E-mail Address: _______________________________________
7. Person to receive egg check samples: ______________________________________________
(Name will be included in shipping address)
Address where egg check samples are to be sent: (If different from above address)
Note: Samples are temperature critical and must be properly stored with analysis beginning on the specified date.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
City: ____________________________________State: ________________ Zip: ____________
9. List the number of employees who participate in Salmonella analysis of pasteurized egg product surveillance samples _______ and fill in the information below for each employee:
Name: Title: Years of Micro. New Employee
Experience (Yes / No)
______________________ _____________________ _____________ ____________
______________________ _____________________ _____________ ____________
______________________ _____________________ _____________ ____________
______________________ _____________________ _____________ ____________
______________________ _____________________ _____________ ____________
10. Our laboratory performs Salmonella analysis on official FSIS egg-product surveillance samples for the following egg product plant (client): (If the lab has more than one client, please list them along with the appropriate information requested below on a separate sheet of paper and attach to this form.)
Plant (client) Name: ____________________________________________________________
Located at: ___________________________________________________________________
City: ______________________________ State: ___________ Zip: ____________
11. For the plant (client) listed above, what types of official samples are analyzed? (Check all that apply.)
Dry __________ Liquid __________ Frozen __________ Other __________
12. For the plant (client) listed above, please indicate the number of official FSIS egg-product surveillance samples that you analyze per week? Dried __________ Liquid __________
13. Does your laboratory use one of the following Salmonella cultural methods for analysis?
The USDA, AMS Laboratory Methods for Egg Products – Sec. I (’93 rev.) and Sec. VII (’94 rev.)? ---------------------------------------- Yes No
The USDA, FSIS MLG online – chapter 4? ------------------------------------ Yes No
The FDA BAM online – chapter 5? --------------------------------------------- Yes No
14. Does your laboratory use any rapid screening method? -------------------------------- Yes No
If yes, please answer the following:
1) Is the rapid method an approved AOAC Official Method of Anaylsis of the AOAC INTERNATIONAL, validated for egg products? ------------- Yes No
If yes, list the name of the rapid method: _____________________
and the AOAC reference number: _____________________
3) Is the rapid method the FSIS Rapid Screening Method as described in the MLG? ------------------------------------------------------------ Yes No
4) Are all positive results that are obtained by rapid screening methods followed up by subculturing the sample and subsequently performing biochemical and serological identification of any Salmonella isolates? ---- Yes No
5) Is a rapid/miniaturized biochemical test system used for identifying Salmonella? -------------------------------------------------------------------------- Yes No
If yes, list the name of the test system: _______________________
and the AOAC reference number: _______________________
15. Are Salmonella-positive results confirmed at your laboratory? ----------------------- Yes No
16. If no, where is the confirmation of Salmonella-positive results conducted?
(NOTE: Confirmation must be completed at another laboratory currently active and in good standing in the PEPRLab Program.)
Confirming Laboratory: _____________________________ PEPRLab No. _______________
Address: ___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
City: _____________________________________ State: ________________ Zip: ____________
17. Have any changes occurred in your laboratory in the last year regarding:
1) Methodology ------------------------------------------------------------------------ Yes No
2) Personnel ---------------------------------------------------------------------------- Yes No
3) Facility Location -------------------------------------------------------------------- Yes No
18. If yes to any of the above, explain below:
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________
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The above information was provided by:
Name: ___________________________________________ Title: ____________________________
Signature: ___________________________________________________ Date __________________
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Instructions for completing the form
Enter the information requested and answer each of the questions as thoroughly as possible. If additional space is needed, write “see attached” in the space after the question and attach any separate sheets of paper to the form.
On page 3 & 4 circle the appropriate response (yes / no).
On page 4:
Print the name of the person completing this form and their title.
The person completing this form must also sign and date the form.
Submit the completed form to:
Program Manager, Pasteurized Egg Products Recognized Laboratory Program
USDA, FSIS, OPHS, LQAD
950 College Station Road
Athens, Georgia 30605
Phone: (706) 546-3559 Fax: (706) 546-3453
E-mail: [email protected]
PEPRL F-0003.01 Effective: 06/22/07 Issuing Authority: Laboratory Quality Assurance Division (LQAD) FSIS
FORM 10,000-8 (06/22/07) Page
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File Type | application/msword |
File Title | The information on this update is considerd proprietary and will not be released |
Author | Steven T. Benson, MQA/QCB |
Last Modified By | joconnell |
File Modified | 2007-12-19 |
File Created | 2007-12-19 |